“WHO is here to implement the country’s priorities”

Dr Tedros Adhanom Ghebreyesus, former foreign and health minister of Ethiopia, is a candidate for the post of the Director General of the World Health Organisation. He was in Nepal to seek support for his candidacy and spoke to Anshrica Dewan of The Himalayan Times about his campaign ‘Together for a healthier life’. Excerpts:

What is the purpose of your visit to Nepal?

I’m a candidate for Director General for the World Health Organisation. Previously I was also the health minister for eight years from 2005 to 2012 and till 2016, I was the foreign minister. The purpose of this visit is that since I’m already focussed on campaigning for the Director General position I came to ask support in Nepal. I find a lot of similarities between Ethiopia and Nepal, including the mountains. We are a multi ethnic country like Nepal, we both are land-locked and boast of ancient civilisations. The challenges we face are also the same and the way we are trying to address them are also the same.

In your opinion what are the ways to achieve system-wide health reforms in Nepal?

When I served as health minister of Ethiopia from 2005-2012,  I tried to understand the global consensus on leading reforms in a country’s health system. The consensus showed that the reforms should be comprehensive and should have all the building blocks of the health system as in service delivery, workforce, information system, pharmaceutical finance and supply system in addressing the shortage of drugs. Then comes emergency response starting with prevention, early detection and rapid response and governance of the health system. So that consensus should be implemented.

In Ethiopia, we brought about very radical reforms covering all these building blocks. We transformed our health system so we now have a very solid primary health care. At the end of the day, prevention is central. Of course, we will have health cases but we can minimise them through prevention. For disease prevention, primary health care is key, because it is close to the community and you can mobilise the community to produce their own health by teaching them prevention skills.

Primary health care being the centre of gravity, service delivery also must be focused on. In just five years, we built more than 16,000 health posts, more than 3,000 health centres and because these need manpower we increased our enrollment rate significantly with all sorts of health professionals. Any system needs strong health management systems, an integrated one so we started a very new management system from the base. We started collecting real time data from the family to understand health conditions better. Now that needs to be financed and government involvement is a must. Also, the budget from donors is important and donor support increases when they see result on the ground. That said, you also need to have sustainable financing and when you introduce the insurance system covering the formal sector and community-based insurance which covers the informal sector (this is a pilot project in Ethiopia, not fully implemented). Then we need to have access to drugs. Now in Ethiopia, we have 95 per cent availability of pharmaceutical drugs in the front line. This comprehensive reform system ensures system-wide reforms.

Nepal is vulnerable to natural disasters. How can WHO work with the Government of Nepal to help strengthen its health systems to better respond to natural disasters and climate change?

I was informed by Health Minister Gagan Thapa that many health posts were destroyed in the 2015 earthquakes and are now under renovation. And, this level of distraction I think needs serious attention from global players and from partners, and WHO should be at the forefront. The proposal of the Health Minister was that WHO should work with the Nepal government, should engage with it, should take its priorities as WHO’s priorities and help Nepal on the basis of these.

I fully agree with him. WHO is here to implement the country’s priorities. WHO should work with the Health Ministry to work on Nepal’s strategic plans to eliminate malaria, for instance, and also to transform the health sector, to achieve universal health goals; WHO should stand by Nepal’s side. That’s what I believe should happen.

How effective are partnerships at the grassroot level for combating health issues?

I believe that the communities should own it. I don’t think it has to be only about partnerships, it should be about owning it. If communities get the right skills and knowledge, they can produce their own health. For instance, if you teach them prevention of malaria, HIV, TB et cetera they can produce their own health. So when we think about health services we talk about a service provider and a service receiver. Of course there are services to be provided like immunisation, assisting a mother in child birth, or giving shots, but there is now the reverse model where you transfer skills and the communities themselves do it. They help themselves. So we should not consider communities as consumers, we should believe that they can produce health if given the right skills and the knowledge. We have to ensure that they own it and then the communities themselves can address most of the problems with communicable and non-communicable diseases.

What is your vision for WHO in the South- Asian region?

I’ve been talking to as many countries as possible. I’ve attended almost all the regional committee meetings and in these meetings some priorities and principles are crystallised. The principles are putting people first, meaning health is a rights issue; putting health at the centre of the global health agenda stating that a healthy society can bring prosperity. Then comes effective partnership and because WHO is thinly spread, it should create focus based on its comparative advantage. WHO should lead from the front and centre and when it leads it should have a combination of technical and political intervention. If you stick to these principles then it will lead to the priorities — reforming WHO, improving its effectiveness, bringing accountability into the organisation, and strengthening the country offices. Achieving these priorities in adherence to the principles is the vision I want to achieve not only in South Asia but worldwide.